Wednesday, July 15, 2009

Fulminant C diff colitis---call the surgeons!

A retrospective study and editorial commentary in Archives of Surgery reviewed the topic of FCDC and cited risk factors for increased mortality. At the risk of cramping our comanagement style, I thought this point was interesting:

Survival rates are higher in patientswho were cared for by surgical vs nonsurgical departments, possiblybecause of more frequent and earlier operations.

The editorial made these points:

Increased patient age, immunosuppression,hypoalbuminemia, significant leukocytosis, and increased serumlactate levels have all been shown, in this or other reviews,to correlate with the need for operation and with ultimate treatmentoutcome. Nevertheless, there is no absolute threshold in anyof these categories and no finding on CT scan, short of pneumoperitoneum,that predicts the need for operation with certainty for an individualpatient.

So when does the patient with C diff colitis have a surgical abdomen? When a good surgeon says they have one!